Hyperbaric Oxygen Therapy Cost with Medicare

Hyperbaric oxygen therapy began as a way to treat deep-sea divers with decompression sickness. Since then, research has shown it to be an effective primary or secondary treatment for numerous medical conditions. During the therapy, you go into a chamber that increases atmospheric pressure exerted on your body while exposing you to high levels of oxygen. Medical providers typically administer it in an outpatient clinic or a hospital. Whether Medicare covers hyperbaric oxygen therapy depends on a few factors.

Does Medicare Cover Hyperbaric Oxygen Therapy?

The Centers for Medicare & Medicaid Services (CMS) establishes rules regarding qualifications for hyperbaric oxygen therapy coverage. If you fit the criteria, Medicare will likely cover the therapy. Which part covers hyperbaric oxygen therapy depends on what type of Medicare plan you have and where you receive treatment.

Medicare Part B

If you have Original Medicare, Medicare Part B is usually what helps pay for hyperbaric oxygen therapy. Medicare Part B covers outpatient therapies and treatments, and in most cases, you receive hyperbaric oxygen therapy on an outpatient basis.

Medicare Part A

If you have Original Medicare and undergo hyperbaric oxygen therapy while hospitalized, Medicare Part A is the portion that will cover the treatment. It's much less common for hyperbaric oxygen therapy to be given as inpatient treatment.

Medicare Part C

If you have Medicare Part C, also known as Medicare Advantage, your plan must cover everything Medicare Parts A and B cover at the minimum. As a result, Medicare Part C plans will usually pay for inpatient and outpatient hyperbaric oxygen therapy following CMS guidelines. In some cases, plans may cover the therapy for other conditions not listed in the CMS rules. Your plan provider can provide you with details about coverage for hyperbaric oxygen therapy.

How Many Diagnoses Are Approved by CMS for Hyperbaric Oxygen Treatment?

The CMS lists 15 conditions that qualify for hyperbaric oxygen treatment. For some diagnoses, you must meet additional requirements for Medicare to cover the therapy.

Generally, Medicare will cover hyperbaric oxygen therapy as a primary treatment for the following conditions:

• Acute carbon monoxide poisoning, which happens if you're suddenly exposed to a large amount of carbon monoxide
  
  
• Decompression illness, which is usually caused by deep-sea diving
  
  
• Gas embolism, when a gas bubble blocks a blood vessel
  
  
• Gas gangrene, a severe bacterial infection usually caused by Clostridium perfringens
  
  
• Acute traumatic peripheral ischemia, loss of blood flow to a limb due to blood loss, trauma, a blood clot or another cause
  
  
• Injuries that result in the crushing of a limb
  
  
• Severed limb that was sutured back in place
  
  
• Progressive necrotizing infections, fast-spreading infections of the skin and soft tissue
  
  
• Acute peripheral arterial insufficiency, when blood is suddenly unable to travel through an artery in an extremity
  
  
• Skin grafts that are at risk of failing
  
  
• Cyanide poisoning

In addition, Medicare will usually cover hyperbaric oxygen therapy for some other conditions, provided you're receiving additional treatments. Hyperbaric oxygen therapy is a Medicare-approved secondary treatment for:

• Chronic refractory osteomyelitis, a recurring bone infection, which Medicare usually only covers the therapy for if other medical interventions and surgeries have failed to treat the infection
  
  
• Actinomycosis, a type of infection
  
  
• Osteoradionecrosis (ORN), a side effect of cancer radiation therapy that causes damage to bones
  
  
• Soft tissue radionecrosis, a side effect of cancer radiation therapy that causes damage to soft tissue

Medicare may also cover hyperbaric oxygen therapy for diabetic wounds on the legs and feet if you meet the following criteria:

• You have Type 1 or Type 2 diabetes
• The wound is due to diabetes
• The wound is severe enough to receive a classification of Wagner grade III
• Standard wound therapy hasn't been effective

If Medicare approves your claim, you usually receive coverage for the therapy for 30 days. At the end of the period, your doctor will need to evaluate your wounds. If the wounds have not improved, Medicare is unlikely to cover additional hyperbaric oxygen therapy. In cases where the wounds do show improvement, Medicare typically approves another 30 days of therapy, after which your doctor must re-evaluate you.

Who Qualifies for Hyperbaric Oxygen Therapy?

To qualify for Medicare coverage for hyperbaric oxygen therapy, you must:

• Have one of the approved medical conditions
• Receive a diagnosis of the medical condition from a doctor who participates in Medicare
• Undergo the therapy in a one-person unit rather than a multiperson room
• Receive therapy from a clinic or hospital that accepts Medicare
• Pay any premiums, copays and coinsurance in accordance with your plan's guidelines

What Conditions Aren't Approved by CMS for Hyperbaric Oxygen Therapy?

Doctors may recommend hyperbaric oxygen therapy for some conditions that Medicare doesn't cover, such as:

• Arthritis
• Exceptional blood loss anemia
• Multiple Sclerosis
• Pulmonary emphysema, a type of lung disease
• Recovery following an organ transplant
• Sickle cell anemia
• Skin burns
• Tetanus

If you undergo hyperbaric oxygen therapy for one of these conditions, Original Medicare normally won't cover it, and you'll have to pay for the cost out of pocket. Medicare Advantage plans may cover therapy for one or more of these conditions.

How Much Will Medicare Pay for Hyperbaric Oxygen Therapy?

How much Medicare will pay for hyperbaric oxygen therapy depends on which part is covering it:

Medicare Part A

If you receive hyperbaric oxygen therapy while hospitalized, the cost is added to your overall hospital bill. You usually pay a deductible and coinsurance based on the length of your hospitalization. Medicare Part A typically pays for the remainder of the hospital bill.

Medicare Part B

When Medicare Part B covers hyperbaric oxygen therapy, your plan usually pays for 80% of the cost, and you pay the remaining 20% out of pocket.

Medicare Part C

How much a Medicare Advantage plan will pay for hyperbaric oxygen therapy depends on the terms of your plan. Typically, a certain percentage is covered, and you pay the remainder as a copay or co-insurance.